This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: March 13, 2007, Volume 115, Number 10 All Versions of this Article: 115/10/1211    most recent CIRCULATIONAHA.106.687152v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Briguori, C. Articles by Colombo, A. Search for Related Content PubMed PubMed Citation Articles by Briguori, C. Articles by Colombo, A. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETYLCYSTEINE ASCORBIC ACID SODIUM ASCORBATE SODIUM BICARBONATE SODIUM CHLORIDE Medline Plus Health Information Kidney Diseases Related Collections Cardiovascular imaging agents/Techniques Coronary imaging: angiography/ultrasound/Doppler/CC Angiography Related Article

(Circulation. 2007;115:1211-1217.)
© 2007 American Heart Association, Inc.

Coronary Heart Disease

Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL)

A Randomized Comparison of 3 Preventive Strategies

Carlo Briguori, MD, PhD; Flavio Airoldi, MD; Davide D’Andrea, MD; Erminio Bonizzoni, PhD; Nuccia Morici, MD; Amelia Focaccio, MD; Iassen Michev, MD; Matteo Montorfano, MD; Mauro Carlino, MD; John Cosgrave, MD; Bruno Ricciardelli, MD; Antonio Colombo, MD

From the Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples (C.B., D.D., A.F., B.R.); Laboratory of Interventional Cardiology, "Vita e Salute" University School of Medicine, San Raffaele Hospital, Milan (C.B., F.A., N.M., I.M., M.M., M.C., J.C., A.C.); and Institute of Medical Statistics and Biometry, University of Milan, Milan (E.B.), Italy.

Correspondence to Carlo Briguori, MD, PhD, Interventional Cardiology, Clinica Mediterranea, Via Orazio, 2, I-80121, Naples, Italy. E-mail briguori.carlo{at}hsr.it

Received December 28, 2006; accepted January 5, 2007.

Background— Volume supplementation by saline infusion combined with N-acetylcysteine (NAC) represents an effective strategy to prevent contrast agent–induced nephrotoxicity (CIN). Preliminary data support the concept that sodium bicarbonate and ascorbic acid also may be effective in preventing CIN.

Methods and Results— Three hundred twenty-six consecutive patients with chronic kidney disease, referred to our institutions for coronary and/or peripheral procedures, were randomly assigned to prophylactic administration of 0.9% saline infusion plus NAC (n=111), sodium bicarbonate infusion plus NAC (n=108), and 0.9% saline plus ascorbic acid plus NAC (n=107). All enrolled patients had serum creatinine 2.0 mg/dL and/or estimated glomerular filtration rate <40 mL · min^–1 · 1.73 m^–2. Contrast nephropathy risk score was calculated in each patient. In all cases, iodixanol (an iso-osmolar, nonionic contrast agent) was administered. The primary end point was an increase of 25% in the creatinine concentration 48 hours after the procedure (CIN). The amount of contrast media administered (179±102, 169±92, and 169±94 mL, respectively; P=0.69) and risk scores (9.1±3.4, 9.5±3.6, and 9.3±3.6; P=0.21) were similar in the 3 groups. CIN occurred in 11 of 111 patients (9.9%) in the saline plus NAC group, in 2 of 108 (1.9%) in the bicarbonate plus NAC group (P=0.019 by Fisher exact test versus saline plus NAC group), and in 11 of 107 (10.3%) in the saline plus ascorbic acid plus NAC group (P=1.00 versus saline plus NAC group).

Conclusions— The strategy of volume supplementation by sodium bicarbonate plus NAC seems to be superior to the combination of normal saline with NAC alone or with the addition of ascorbic acid in preventing CIN in patients at medium to high risk.

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